The long-term objective of this programmatic line of research is to elucidate the relation of early oral language, phonological processing, and orthographic knowledge and literacy achievement for children with hearing loss who are developing spoken language. This translational work supports NIDCD's mission of reducing the burden of communication disorders such as hearing loss and will result in better methods of identifying preschool children with hearing loss who are at-risk for later language and literacy deficits. Children with hearing loss have wide individual variation in literacy outcomes. The median reading outcome for 18-year-olds with hearing loss is at only a third grade level, but some researchers report reading levels within the average range. Thus, there is a critical need to develop methods of identifying which children with hearing loss in the preschool years are at-risk for later deficits so intervention can be initiated as early as possible. For children with normal hearing, early language, phonological, and orthographic skills develop over the course of the preschool years and are moderate to strong predictors of later literacy achievement. Children with hearing loss exhibit difficulties in acquisition of each of these early language, phonological, and orthographic skills; however, the developmental trajectories and the contribution of each early language, phonological, and orthographic skill to literacy achievement for children with hearing loss are unknown. The aims of this longitudinal study are to (a) determine the developmental trajectories of early language, phonological, and orthographic skills for children with hearing loss across the preschool years and (b) determine the unique contributions of preschool oral language, phonological processing, and orthographic skills to initial literacy achievement in children with hearing loss at age 6. This study will provide a bettr understanding about how early language, phonological, and orthographic skills develop and contribute to literacy achievement in children with hearing loss. Such knowledge will have a significant long-term impact on identification of preschool children with hearing loss who are at-risk for later spoken language and literacy deficits.